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Date of Event
Local Time of Event
Include your suggestions on how to prevent similar occurrences.
Did the event occur.....
In the air
On the ground and involved an aircraft
On the ground
In your opinion, what is the likelihood of such an event or similar, happening again
Rare - almost inconceivable it will happen
Unlikely - could happen, but not known to have done so
Possible - might do at sometime
Likely - more likely than not
Almost certain - expected to happen
What do you consider to be the worst possible consequence if this event did happen or happened again?
Negligible - nuisance, no injuries
Low - minor incident, first aid required
Moderate - medical treatment, low damage
Significant - injuries, major damage to equipment
Catastrophic - fatality, equipment destroyed
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